Behavioral Health: Public Health Challenge Public Health Opportunity Pamela S. Hyde, J.D. SAMHSA Administrator American Public Health Association 139 th Annual Meeting and Exposition Washington, DC October 30, 2011

MAKING THE CASE BEHAVIORAL HEALTH: AMERICA’S #1 PUBLIC HEALTH CHALLENGE GLOBAL & DOMESTIC IMPACTS CHANGING THE CONVERSATION: A NATIONAL DIALOGUE 3

 By 2020, mental & substance use disorders (M/SUDs) will surpass all physical diseases as a major cause of disability worldwide  One-half of U.S. adults will develop at least one mental illness in their lifetime U.S. 2006: M/SUDs were 3 rd most costly health condition behind heart conditions and injury-related disorders Mental illness and heart diseases alone account for almost 70 percent of lost output/productivity BEHAVIORAL HEALTH IMPACTS 4

 M/SUDs: almost ¼ of all adult stays in community hospitals  percent of all cigarettes consumed in the U.S. are by individuals with M/SUDs  Up to 83 percent of people w/Serious Mental Illness (SMI) are overweight or obese BEHAVIORAL HEALTH IS ESSENTIAL TO HEALTH 5

M/SUDs RELATED DEATHS & DISEASE  Drug deaths now outnumber traffic fatalities  People w/SMI have shortened life-spans, w/high rates of co- morbidities 69 percent of adults w/SMI report at least one medical disorder Health care costs higher with co-morbid BH conditions Hypertension: 2x the cost of those w/out BH conditions Coronary Heart Disease: 3x the cost Diabetes: 4x the cost  Nearly 5,000 deaths each year attributable to underage drinking  Deaths by suicide outnumber homicides and deaths from HIV/AIDS 6

10 Leading Causes of Death, United States 2008, All Races, Both Sexes RANKALL AGES 1. Heart Disease: 616, Malignant Neoplasms: 565,469 3.Chronic Low Respiratory Disease: 141, Cerebro-vascular : 134, Unintentional Injury: 121, Alzheimer's Disease: 82, Diabetes Mellitus: 70, Influenza & Pneumonia: 56, Nephritis: 48, Suicide: 36,035 WISQARS TM Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System 7

TOUGH REALITIES 8

MISSED OPPORTUNITIES = LIVES LOST 77 percent of individuals who die by suicide had visited their primary care doctor within the year 45 percent had visited their primary care doctor within the month THE QUESTION OF SUICIDE WAS SELDOM RAISED… 9 18 percent of elderly patients visited their primary care doctor on same day as their suicide

IMPACT OF TRAUMA  Childhood trauma is extensive > 6 in 10 U.S. youth have been exposed to violence within the past year; nearly 1 in 10 injured 772,000 children were victims of maltreatment in 2008  Adverse childhood experiences (ACEs, e.g., physical, emotional, and sexual abuse, as well as family dysfunction) associated with mental illness, suicidality, substance abuse, and physical illnesses Potentially explain 32.4 percent of M/SUDs in adulthood 10

PREVENTION WORKS  2009 IOM Report Preventing Mental, Emotional, and Behavioral Disorders among Young People: Progress and Possibilities Among adults, half of all mental, emotional and behavioral (MEB) disorders were first diagnosed by age 14 and three-fourths by age 24 MEB disorders among youth as commonplace as fractured limb Risk and resiliency factors can be addressed Common, early, consistent, multi-sector, continuous, community- based PUBLIC HEALTH approaches work Environmental, policy, culture and individual approaches work 11

CHRONIC DISEASES: GLOBAL IMPACT World Economic Forum: Global economic impact of 5 diseases could reach $47 trillion over the next 20 years MH will account for $16 trillion – a third of cost CancerDiabetes Mental Illness Heart Disease Respiratory Disease 12

ECONOMIC IMPACT ON AMERICA THE ECONOMY Estimated total societal cost of substance abuse in the U.S. is $510.8 billion per year Economic costs of mental, emotional, and behavioral disorders among youth ~ $247 billion Alcohol and drug abuse & dependence: ~ $263 billion in lost productivity costs per year Mental disorders: ~$94 billion in lost productivity costs per year 13

TREATMENT IS EFFECTIVE, BUT Today in America over 60 percent of people (>26 million) who experience mental health problems and almost 90 percent of people (>20 million) who need substance abuse treatment do not receive care 14

DAILY DISASTER OF UNPREVENTED AND UNTREATED M/SUDs Any MI: 45.1 million 37.9 % receiving treatment SUD: 22.5 million 11.6 % receiving treatment Diabetes: 25.8 million 84 % receiving treatment Heart Disease: 81.1 million 74.6 % receiving screenings Hypertension: 74.5 million 70.4% receiving treatment 15

Public Health Social Problem Insufficient Response Attention to Symptoms Individual Blame National Dialogue Health Needs of People & Communities PUBLIC HEALTH OR SOCIAL PROBLEM? 16

TRAGEDIES Grand Rapids, MI 2011 – 8 Lost Tucson, AZ 2011 – 6 Lost Red Lake Band of Chippewa, MN, 2005 – 10 Lost Asher Brown 2010 – 1 Lost 13 yrs old 17 Virginia Tech, VA Lost Columbine High School, TX Lost West Nickle Mines School, PA 2007 – 6 Lost

FROM EVENTS TO ASSUMPTIONS...  Individual Blame Misunderstanding Prejudice Discrimination Moral judgment Social exclusion 18

LEADING TO INSUFFICIENT RESPONSES Increased Security & Police Protection Tightened Background Checks & Access to Weapons Legal Control of Perpetrators & Their Treatment More Jail Cells & Homeless Shelters & JJ Facilities Institutional/ System/ Provider Oversight 19

WHAT AMERICANS KNOW  Most Know or Are Taught: Basic First Aid and CPR for physical health crisis Universal sign for choking; facial expressions of physical pain; basic terminology to recognize blood and other physical symptoms of illness and injury Basic nutrition and physical health care requirements Where to go or who to call in an emergency 20

WHAT AMERICANS DON’T KNOW  Most Do Not Know and Are Not Taught: Signs of suicide, addiction or mental illness or what to do about them or how to find help for self or others Relationship of behavioral health to individual or community health or to health care costs Relationship of early childhood trauma to adult physical & mental/substance use disorders 21

SO, HOW DO WE CREATE...  A national dialogue on the role of BH in public life  With a public health approach that: Engages everyone – general public, elected officials, schools, parents, community coalitions, churches, health professionals, researchers, persons directly affected by mental illness/addiction & their families Is based on data, facts, science, common understandings/messages Is focused on prevention (healthy communities) Is committed to the health of everyone (social inclusion) 22

HELP US CHANGE THE CONVERSATION! National Dialogue 23

SAMHSA’S HERE TO HELP YOU 1. Prevention 2. Trauma and Justice 3. Military Families 4. Recovery Support 5. Health Reform 6. Health Information Technology 7. Data, Outcomes & Quality 8. Public Awareness & Support 24